Healthcare Provider Details

I. General information

NPI: 1316942147
Provider Name (Legal Business Name): JAMES LEO SHOEMAKER DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/11/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013B WEST JUDGE PEREZ DRIVE
CHALMETTE LA
70043
US

IV. Provider business mailing address

205/206 HIGHPOINT DRIVE
DIAMONDHEAD MS
39525
US

V. Phone/Fax

Practice location:
  • Phone: 504-271-6500
  • Fax: 504-279-7778
Mailing address:
  • Phone: 985-710-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number684
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number684
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number684
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number684
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number684
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: